Hepatotoxicity related to total parenteral nutrition: Comparison of low-lipid and lipid-supplemented solutions

The Hepatotoxicity of Antifungal Medications in Bone Marrow Transplant Recipients

“…An association between parenteral nutrition and hepatotoxicity has been established, although it is unclear whether the lipid or the carbohydrate component is more important in this association [18][19][20][21]. To explore this association, we recorded the total amount of lipids, amino acids, and dextrose infused during parenteral nutrition.…”

Parenteral Nutrition‐Associated Liver Complications in Children

“…18,171,172 No statistically significant differences were found in elevations from baseline of serum alkaline phosphatase and AST concentrations when a high lipid (30% calories as lipid) and low lipid (2.5% calories as lipid) parenteral nutrition were compared. 173 The emulsions appear safe when given to children at dosages not exceeding 3 g/kg/day. In case of hypertriglyceridemia, the dosage should be reduced to 0.5-1 g/kg/day to provide enough linoleic acid to prevent essential fatty acid deficiency.…”

“…174 A lipid:energy ratio of 25-30% is appropriate to provide balanced caloric intake. 167,173 Lipid emulsions in the United States are made of long-chain triglycerides (LCT) derived from soybean or soybean-safflower oil. Considering the faster oxidation rate of medium-chain triglycerides (MCT) compared with LCT, early animal and human data suggest that the MCT-LCT mixture may be better tolerated and may be less likely to cause hepatic dysfunction.…”

Lipid emulsions – Guidelines on Parenteral Nutrition, Chapter 6

“…In adult patients with gastrointestinal disorders, administration of PN containing soybean oil, which provided either 2.5% or 30% of non-protein energy over a two-week period, did not result in significant differences in ALT (alanine transferase), AST (aspartate transferase) and alkaline phosphatase between the two groups ([32]; Ib). In critically ill patients, an excessive intake of glucose increases hepatic lipogenesis [33], [34], [35], [36], whereas intravenous lipids reduce the dependency on glucose as an energy source.…”